Exam 2 Pages 1-43

decomposition changes

postmortem discolorations which are due to the action of bacterial and/or autolytic enzymes on the body tissues. there may be progressive color changes in the tissues if enzymes are not inhibited. yellow to light green to dark green to blue black to marbling

Antemortem extravascular blood discolorations

purpura, ecchymosis, petechia, and hematoma

How much fluid to use to flush intravascular blood discolorations?

quantity should be such as would fill and flush all parts of the vascular system but would not cause rupturing of the vascular system to convert the intravascular discoloration to an extravascular type. this is accomplished by slow injection pressure and rate of flow

List of postembalming postmortem discolorations

razor burns or desiccation marks, formaldehyde grey (requires total drainage and active dye to treat), jaundice cases turning green, and eye enucleation bruises

List of non-pathological discolorations causes

refrigeration, hanging, burns, poisons, mutilation, gunshot, carbon monoxide poisoning, drowning, exsanguination, electrocution

Treating peritonitis

restricted cervical method, utilization of multiple injection/drainage sites if necessary. immediate aspiration and injection of undiluted cavity fluid at least 2 bottles after arterial injection. reaspiration and injection of additional undiluted cavity fluid prior to dressing and casketing.

green discoloration

results from high formaldehyde index solutions converting bilirubin to biliverdin in a jaundice body. also caused by an acidic environment

Jaundice/icterus

results in a yellowish discoloration of the body which is first detected in the sclera of the eye. the yellow stain is due to the presence of bilirubin pigmentation which adversely colors the bile. strong formaldehyde arterial solutions (with higher pH levels) adversely affects bilirubin and converts the yellow discoloration to green, changing bilirubin to biliverdin.

Treatment for lupus vulgaris

routine arterial injection will have little affect on ulcers. pack application of undiluted cavity fluid and topical jelly wit a phenol base. can also hypodermically inject arterial fluid into problem areas

Treatment for addison's disease

same as jaundice, low index or specialized arterial fluid. high index may cause surface tissue to turn dark

What to do if the discoloration is localized

sectional arterial injection and drainage may be used

Tan discoloration

seen in the sclera of the eye due to postmortem dehydration

Treating leukemia

start with right common carotid artery and right internal jugular vein followed by multiple injection and drainage sites where necessary to solve injection and drainage problems

Chemistry for leukemia

stronger solutions with coinjection to assist distribution of fluid solution

What to do if jaundice fluid is unavailable

substitute low index fluid containing bleaching agents or use larger solution volumes of weaker arterial solutions

formaldehyde grey

the chemical combination of formaldehyde with hemoglobin results in the formation of a substance called methemoglobin or formaldehyde grey. with the passage of time, color changes from pink to a dark slate gray. can happen with all complexions, and is more susceptible to darker complexions. cover with opaque cosmetics

Treatment of tumor

the tumor will seldom be preserved by arterial injection. it should be excised completely and the area preserved with topical jelly, cavity pack, and/or treated hypodermically. restorative art procedures required as necessary

Mechanical aids with intravascular blood discolorations

to assist in increasing the flow of injection chemicals to the region of the discoloration and to assist the flow of venous blood drainage from the part, you can alternatively raise and lower the part, and manually massage towards the heart with proper skin lubrication

Lupus vulgaris

tuberculosis of the skin characterized by patches which break down and ulcerate, leaving scars. in some cases, a red butterfly rash may appear across the nose and cheeks. ulcers may be contagious to the embalmer

Mechanically removing surface discoloring agents

use an abrading device and wash with suitable cleaning agents and soft cloths or brushes; can cause desiccation marks. use the soft side of the sponge

What to do with a jaundice case if preservation demand is low

use femoral artery as injection site with two drainage sites, right internal jugular vein and right femoral vein

Chemistry with jaundice case

use preinjection solution to flush out as much blood drainage as possible. use special jaundice fluids especially manufactured for this purpose. bleaching coinjection solutions (often called two step fluids) to augment abundance of active dyes (usually eosin)

Chemically removing surface discoloring agents

use proper solvent when discoloration cannot be removed by mechanical cleaning. waterless hand cleaner or dry wash.

What to do with a jaundice case requiring high preservation demand

use restricted cervical method; strong solution to preserve torso especially if edema is present, milder of special jaundice solutions for head and hands.

Treating decomposition discolorations

use sectional hypodermic injections of chemicals designed to bleach and preserve. surface compresses saturated with a proper bleaching agent. use bleaching cavity fluid, phenol, and topical jelly

Liver targeting drugs

will result in jaundice because of their toxicity, usually occurs just prior to death

Radiation: substances used in diagnosis and treatment

Cobalt, Iodine, Phosphorus, Radium, Gold, and SR

Methods to reduce extravascular blood discolorations

Incising an area directly or puncturing and channeling it to drain the extravasated blood, sectional or hypodermic injection of chemicals designed to bleach and preserve discolored areas, and applying surface pack or cavity pack to bleach the area

Can extravascular blood discolorations be removed?

No. they require certain operative aids or corrective procedures

Non-pathological discolorations

Non-pathological conditions that lead to discoloration, also known as unnatural conditions

hematoma

a blood filled swelling; a collection of blood in a tumor-like mass, simply a blood blister

Addison's disease

a bronze discoloration resulting from loss of function in the adrenal glands

Carbon monoxide poisoning

a cherry red blood discoloration on the body surface. the blood will lose its ability to coagulate; thus it tends to be in a liquid state causing the cherry red blood discoloration to be more intense. if not embalmed soon after death, this will cause a stain

Leukemia

a chronic or acute disease of unknown etiology characterized by unrestrained growth of leukocytes. causes capillary congestion and extensive thrombosis which may severely limit drainage to only a few ounces of a pale, sticky liquid which may not even resemble blood. tissue may also have a puttylike cast on the surface with a gray hue

Antemortem discoloration

a discoloration which appears on the human body during life. the fact that it may remain after life is extinct will not cause change of its classification

postmortem discoloration

a discoloration which makes it appearance on the human body only after the death of the body

Chronic renal failure

a sallow yellow color to the skin resulting from the presence of urochrome in the tissues. often accompanies diabetes mellitus, which adversely affects distribution and diffusion of arterial solution. poor peripheral circulation leading to gangrene of lower limbs and conversion of urea in bloodstream to ammonia that neutralizes formaldehyde are the major problems faced by the embalmer

Green

a spot about the size of a silver dollar will appear over the cecum indicating the activity of e. coli. in time this green discoloration will spread over the entire body if the body is not embalmed properly and in a timely manner

List of surface discoloring agents

adhesive tape, blood, grease, ink, iodine, mercurochrome, metaphen, mold, oil, paint, tincture of benzene, tobacco tars, and varnish

Treating surface discoloring agents

always remove these prior to embalming. can be done mechanically or chemically

Fluid accumulation according to location

anasarca - generalized edema ascites - edema of the abdominal or peritoneal cavity hydrothorax - edema in the plural cavity hydrocephalus - intracranial edema hydropericardium - edema in the pericardial cavity hydrocele - testicular edema (or any sacculated part)

All drug discolorations are

antemortem and are caused by specific drugs or combinations of drugs. most common are jaundice over the entire body and hemorrhagic discolorations usually on the arms

Pathological discoloration

antemortem discoloration which occurs during the course of certain disease

Pharmaceutical agents

antemortem discolorations resulting from the administration of pharmaceuticals or chemotherapeutic agents

Pathological discolorations

antemortem discolorations which occur during the course of certain disease

Surface discoloring agents

antemortem or postmortem discolorations which occur prior to or during embalming due to the deposit of matter on the body surface

Red to purple

associated with livor mortis eventually followed by postmortem stain

Conditions predisposing to vascular difficulties

atheroma, arteriosclerosis, varices, clots, emboli (in the vein), phlebitis, thrombosis (in the artery), hemorrhage, endocarditis, tuberculosis, febrile diseases, tumors, freezing, gangrene, gunshot, mutilation, severances, corrosive poisons, asphyxiation, pneumonia, burns, syphilis, leukemia, hanging, shock, advanced decomposition

Chemistry for peritonitis

avoid preinjection and use strong solutions and coinjection instead. reaspirate adding fresh cavity fluid each time

Treating chronic renal failure

avoid preinjection completely. use high index fluid with coinjection of drainage chemicals. multiple injection and drainage sites will be necessary. hypodermic injection of areas that did not receive solution. use active dyes as coinjection to offset sallow yellow

eye enucleation bruises

basically a black eye. result from damage to tissue and capillaries during enucleation. cavity fluid pack with bleaching cavity fluid followed by opaque cosmetics. can also be treated with channeling

Ecchymosis/Bruise/Contusion/Suggulation

bruise from trauma, extravasation of blood under the surface tissue

Purpura

bruising due to capillary vascular damage or disease

Razor burns

caused by dehydrating effects of the air to damaged epidermis, makes a reddish brown discoloration. becomes progressively worse as time goes on. requires opaque cosmetics

postmortem stain/laking

caused by hemolysis, aka destruction of red blood cells. if the postmortem interval is long enough and the blood remains liquid, especially aided by refrigeration, the body will go from livor mortis to postmortem stain at a faster rate

dry gangrene

caused by the interference of the arterial supply of the blood. dry gangrene can result in a bluish-black discoloration with little odor as the bacterial activity is limited by dryness of the tissues

Wet gangrene

caused by venous congestion where the affected part becomes moist, dark, and putrid and has the odor of rotting flesh. spreads rapidly

Atabrine

causes a brown discoloration

Methylene blue

causes a distinct blue discoloration which will be converted into a green discoloration if the formaldehyde solution used to embalm the body is too strong; will show in the sclera of the eye if present in the vascular system

Sulfa/sulfur

causes a yellow discoloration that is not jaundice yellow

Radium

causes burns that will give red discolorations

post embalming preparation of a case to be shipped

close and seal all incisions, treatment of all orifices, terminal disinfection of the body, leakage precautions - plastic garments like coveralls, stabilizing techniques in the casket or shipping case, and embalming report

COPSA

color change, odor, purge, skinslip/desquamation, and accumulated gases

How to counteract formaldehyde grey

completely flush the venous system, keep the head above the chest and the chest above the stomach, and use active dyes i.e. counter staining compounds to impart a more lifelike appearance.

Maroon

decomposition of the arterial system causing the vasa vasorum to deteriorate changing the artery to maroon; looks like muscle tissue making visual of the artery difficult

Blood discolorations

discolorations resulting from changes in blood composition, content or location. intravascular blood discolorations either antemortem or postmortem are easily removed by vascular and injection drainage. extravascular discolorations are not substantially reduced

Embalming conditions associated with edema

distension of tissue, secondary dilution of fluid, desquamation aka skin slip, distortion of body contour, and possible leakage

Dyes to treat jaundice

excessive amounts of active dyes are used to counter stain shades of green and must enter both common carotids uniformly (necessitating restricted cervical method or femoral injection site). we use active dyes as counter staining compounds to hide the stain

general treatment of intravascular blood discolorations

flush the vascular system of the discolored area by having sufficient drainage. the type and strength of the fluid should be such that the blood will not be further modified to set the discoloration. this is accomplished by water conditioners and anticoagulants

Conditions causing pathological discolorations

gangrene (wet and dry), jaundice/icterus, addison's disease, leukemia, tumors, meningitis, peritonitis, and lupus vulgaris

Special chemicals to deal with decomposition

hardening compound, deodorant powder, deodorant spray, sealer, reducing and bleaching agents, disinfecting chemicals, and preservative powder

Postmortem extravascular discolorations are caused by

hemoglobin decomposition

Conditions predisposing to dehydration

hemorrhage, febrile disease, tuberculosis, burns, refrigeration

Common contagious or infectious diseases

hepatitis, tuberculosis, pneumonia, influenza, meningitis, syphilis, scarlet fever, poliomyelitis, rabies, diphtheria, AIDS, herpes, legionnaires disease, and CJD

Conditions predisposing to decomposition

hydrocephalus, edematous cases, peritonitis, burns, gangrene, mutilations, advanced pregnancy (maceration in amniotic sac), and febrile cases

Conditions causing deformities and malformations

hydrocephalus, paralytic conditions, tumors, general decomposition, hanging, mutilations, corrosive poisonings, burns, arthritis, congenital conditions, fractures, crushing

how to tell between intravascular and extravascular

if it changes color upon palpation, it's intravascular

Treating gangrene

if odor is present, use spray disinfectant. use high index fluids on affected areas through multiple injection sites or hypodermically with a hypo-valve trocar. cavity packs should be applied to the entire area. then use plastic garments with necessary accessory chemicals. goal is to preserve, prevent leakage and the escape of odor

What can assist in ensure vascular filling of injection chemicals?

increased pressure and limited drainage. the resulting distention of the vessels may aid in the removal of blood. intravascular blood discolorations can be substantially reduced

Meningococcal meningitis

infectious and contagious disease which causes an inflammation of the membranes of the spinal cord and/or brain. a clear danger to the embalmer who should follow proper procedures for this. can cause a rash

Peritonitis

inflammation of the peritoneum due to the invasion of infectious organisms. a bright red color is characteristic of the infected peritoneum lining the abdominal cavity. this will cause hypostasis to hemolysis rapidly because the blood in its antemortem state was unable to coagulate because of bacterial invasion. the blood will have an odor of putrefaction and will be dark in color

Treatment for jaundice

jaundice chemicals with a low index, restricted cervical injection, use a minimum of two drainage sites, pack applications of bleaching chemicals, opaque cosmetics, and tortiare lamps

Postmortem discoloration

may be present before embalming but has become more intense, changed in hue, or may have evolved due to embalming; postembalming

Why remove surface discoloring agents before embalming?

may conceal signs of fluid distribution or diffusion. most are difficult to remove after tissues have firmed. more difficult to remove after because the pores will be deeper and then harder to get out

senile gangrene

most common form of dry gangrene and is frequently seen in the extremities of the body

livor mortis/cadaveric lividity/postmortem lividity

most common postmortem intravascular blood discoloration. a reddish blue discoloration resulting from hypostasis

Gangrene

necrosis of tissue cells that undergo bacterial composition

Capillary congestion

occurs during the agonal period just prior to death

Hypostasis

occurs during the agonal period which results in a bluish purple discoloration most noticeable in the elderly. leads to livor mortis

Extravascular blood discolorations

occurs outside of the vascular system

Active capillary congestion

occurs when the arterial supply to an area of the body is increased

Passive capillary congestion

occurs when venous drainage from an area is decreased

Intravascular blood discolorations

occurs within the vascular system, can be antemortem or postmortem

Discolorations

only those discolorations which normally are removed during routine embalming procedures and those which may be altered sufficiently during routine embalming procedures to make their concealment less difficult by the restorative artist

Treating meningococcal meningitis

opaque cosmetics

Other jaundice treatment

opaque cosmetics to conceal discolorations, and special lighting in visitation rooms

Tumors

pathological discoloration will vary in both benign as well as in malignant tumors. odor may also be a problem if the tumor is necrotic

Conditions associated with edema

phlebitis, heart failure, cirrhosis of the liver, nephritis, lymph vessel obstruction (cancer or parasites), carbon monoxide poisoning, burns, and alcoholism

Petechia

pinpoint bleeding aka hemorrhagic effusion

Reaction of embalming chemicals upon body contents

postmortem discoloration that may be present before embalming but has become more intense, changed in hue, or may have evolved due to embalming